{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T19:04:56Z","timestamp":1788030296449,"version":"build-2784847793"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Most Hirschsprung's disease (HD) are diagnosed in young children with increased risk (\u201dred flag\u201d). Older children (&gt;6 months) require open rectal biopsy (ORB) with its own impact on risk and resources. We investigated if \u201cred flag\u201d, age, and sex used in combination could exclude HD.<\/jats:p><jats:p>\n          Materials and Methods\u2003\u201cRed flags\u201d are risk factors associated with HD, including neonatal bowel obstruction, genetic association, failure of passage of meconium in &lt;48\u2009hours, infantile constipation, distension with vomiting, or family history. All rectal biopsies (2015\u20132018) were reviewed for indications, methods, and histopathological findings. Logistic regression analysis was adopted to assess predictive value of \u201cred flag,\u201d age, and sex (p\u2009&lt;\u20090.05* was significant).<\/jats:p><jats:p>\n          Results\u2003A total of 187 children underwent 84 suction rectal biopsies and 113 ORBs (n\u2009=\u2009197 in total). Final histopathological diagnoses were non-HD (n\u2009=\u2009154) and HD (n\u2009=\u200943). Total 78% of rectal biopsies were non-HD, of which 63% by ORB. Non-HD was associated with absence of \u201cred flag\u201d (49 vs. 16%*), increased age at biopsy (22 months vs. 28 days*), &gt;6 months old (62 vs. 30%*), and female gender (54 vs. 16%*), compared with HD. In the absence of \u201cred flag,\u201d 7\/82 (9%) had HD (negative predictive value\u2009=\u200991%). Logistic regression analysis found absent \u201cred flag\u201d predicted non-HD biopsy with odds ratio 4.77 (1.38, 16.47), corrected for age and sex.<\/jats:p><jats:p>\n          Conclusion\u2003Negative rectal biopsy rate for HD is very high. The majority required ORB. Although \u201cred flag\u201d and gender, but not age, have strong predictive values, it is inadequate for excluding HD. This study supports the need for alternative strategies in excluding HD.<\/jats:p>","DOI":"10.1055\/s-0041-1722858","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T22:30:42Z","timestamp":1612823442000},"page":"184-190","source":"Crossref","is-referenced-by-count":3,"title":["A Critical Analysis of Rectal Biopsy to Exclude Hirschsprung's Disease"],"prefix":"10.1055","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5878-0471","authenticated-orcid":false,"given":"Yew-Wei","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Sofia","family":"Chacon","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Sherwood","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munther","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Choudhry","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United 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Int"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1136\/adc.79.3.266","article-title":"Rectal biopsy in the investigation of constipation","volume":"79","author":"A Ghosh","year":"1998","journal-title":"Arch Dis Child"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1007\/s00383-015-3742-8","article-title":"Rectal suction biopsy for the diagnosis of Hirschsprung's disease: a systematic review of diagnostic accuracy and complications","volume":"31","author":"F Friedmacher","year":"2015","journal-title":"Pediatr Surg Int"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s00383-002-0934-9","article-title":"The constipated child: how likely is Hirschsprung's disease?","volume":"19","author":"A R Khan","year":"2003","journal-title":"Pediatr Surg Int"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1055\/s-0029-1241820","article-title":"Rectal biopsy for Hirschsprung's disease--are we performing too many?","volume":"20","author":"N Rahman","year":"2010","journal-title":"Eur J Pediatr Surg"},{"issue":"09","key":"ref9","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1007\/s00383-013-3361-1","article-title":"Hirschsprung's disease associated with Down syndrome: a meta-analysis of incidence, functional outcomes and mortality","volume":"29","author":"F Friedmacher","year":"2013","journal-title":"Pediatr Surg Int"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/MOP.0000000000000345","article-title":"Surgical options for the management of severe functional constipation in children","volume":"28","author":"R J Wood","year":"2016","journal-title":"Curr Opin Pediatr"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bpg.2010.12.010","article-title":"Epidemiology of constipation in children and adults: a systematic review","volume":"25","author":"S M Mugie","year":"2011","journal-title":"Best Pract Res Clin Gastroenterol"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/MPG.0000000000000266","article-title":"Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN","volume":"58","author":"M M Tabbers","year":"2014","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1016\/j.jpedsurg.2012.04.022","article-title":"Late diagnosis of Hirschsprung's disease \u2013 patient characteristics and results","volume":"47","author":"K J Stensrud","year":"2013","journal-title":"J Ped Surg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1053\/jpsu.2003.50070","article-title":"Diagnosing Hirschsprung's disease: increasing the odds of a positive rectal biopsy result","volume":"38","author":"N A Lewis","year":"2003","journal-title":"J Pediatr Surg"},{"issue":"09","key":"ref16","first-page":"881","article-title":"How useful is the barium enema in the diagnosis of infantile Hirschsprung's disease?","volume":"140","author":"T L Taxman","year":"1986","journal-title":"Am J Dis Child"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1471-2431-7-5","article-title":"Application of a plain abdominal radiograph transition zone (PARTZ) in Hirschsprung's disease","volume":"7","author":"A Pratap","year":"2007","journal-title":"BMC Pediatr"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/0009922806289328","article-title":"Use of the recto-sigmoid index to diagnose Hirschsprung's disease","volume":"46","author":"R Garcia","year":"2007","journal-title":"Clin Pediatr (Phila)"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1097\/01.mpg.0000214164.90939.92","article-title":"Diagnostic tests in Hirschsprung disease: a systematic review","volume":"42","author":"F de Lorijn","year":"2006","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00383-008-2293-7","article-title":"Preliminary evaluation of anorectal manometry in diagnosing Hirschsprung's disease in neonates","volume":"25","author":"Y Huang","year":"2009","journal-title":"Pediatr Surg Int"},{"issue":"12","key":"ref22","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1016\/j.jpedsurg.2007.08.034","article-title":"Anorectal sleeve micromanometry for the diagnosis of Hirschsprung's disease in newborns","volume":"42","author":"H Kawahara","year":"2007","journal-title":"J Pediatr Surg"},{"issue":"03","key":"ref23","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/MPG.0000000000002000","article-title":"Anorectal manometry may reduce the number of rectal suction biopsy procedures needed to diagnose Hirschsprung disease","volume":"67","author":"R J Meinds","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"06","key":"ref24","doi-asserted-by":"crossref","first-page":"e13797","DOI":"10.1111\/nmo.13797","article-title":"Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement","volume":"32","author":"E Athanasakos","year":"2020","journal-title":"Neurogastroenterol Motil"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.cpem.2010.09.001","article-title":"Nonpharmacologic techniques for distress reduction during emergency medical care: a review","volume":"11","author":"C Eldridge","year":"2010","journal-title":"Clin Pediatr Emerg Med"},{"issue":"S 02","key":"ref26","first-page":"E3","article-title":"Using play specialist therapy to reduce the use of sedation for anorectal manometry tests","volume":"50","author":"D Rawat","year":"2010","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"7569194","DOI":"10.1155\/2019\/7569194","article-title":"Effects of a psychological preparation intervention on anxiety associated with pediatric anorectal manometry","volume":"2019","author":"K Lamparyk","year":"2019","journal-title":"Int J Pediatr"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00383-016-4010-2","article-title":"The evaluation of rectal mucosal punch biopsy in the diagnosis of Hirschsprung's disease: a 30-year experience of 954 patients","volume":"33","author":"K Yoshimaru","year":"2017","journal-title":"Pediatr Surg Int"}],"container-title":["European 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